ABSTRACT

In the 1970s, about 20 years later than in other Western European countries and the USA, a major reform process of the psychiatric service system began in Germany.1 It was inspired by the Psychiatrie-Enquête (PsychiatrieEnquête, 1975), which itself was an expression of a general atmosphere of social reform that characterised the Federal Republic of Germany (FRG) during that time.2 A commission of 23 experts and a range of international and national advisers contributed. The commission presented a report to the West German parliament which was based on extensive data collection on all branches of the psychiatric service system. It was concluded that the condition of care for the mentally ill was in a horrifying state; that is, their needs were neglected and many of them were occupying long-term custodial institutions with substandard care and inhumane living conditions, at times including low staffing levels. Even though this had been known for more than a decade (Bauer et al, 2001), it obviously took a long time to convince the majority of mental health professionals and their organisations that things were no longer tolerable. These were turbulent times characterised by often fierce ideological disputes between ‘old-school’ psychiatrists, some of whom

had been involved in the systematic extermination of the mentally ill during the Nazi era, and reformers, who were partly influenced by the civil rights and political protest movement (Bauer, 2003).